Physical Activity: Park, Trail, and Greenway Infrastructure Interventions when Implemented Alone

Summary of CPSTF Finding

The Community Preventive Services Task Force (CPSTF) finds insufficient evidence to determine whether park, trail, and greenway infrastructure improvements increase physical activity when they are implemented without additional interventions. Evidence was considered insufficient because changes in physical activity were inconsistent. Studies did find meaningful increases in the number of people using parks, trails, and greenways following infrastructure improvements.

CPSTF recommends park, trail, and greenway infrastructure interventions when combined with additional interventions.

Intervention

Park, trail, and greenway infrastructure interventions improve the built and natural environments by creating or enhancing public locations for physical activity, relaxation, social interaction, and enjoyment. Locations include the following:

  • Parks designated public areas that often combine greenery with paths, facilities for physical activity and recreation, and places for relaxation and social interaction
  • Trails and Greenways routes for walking, hiking, or cycling in urban, suburban, or rural areas (e.g., “rails to trails” conversion projects). These may involve street conversions that provide opportunities for walking and cycling (most often in urban areas).

CPSTF Finding and Rationale Statement

Read the full CPSTF Finding and Rationale Statement for details including implementation issues, possible added benefits, potential harms, and evidence gaps.

About The Systematic Review

The CPSTF finding is based on a systematic review of 38 studies (published through July 2020). Seventeen of the studies evaluated intervention that evaluated infrastructure interventions when used alone. Studies were identified from two sources:

  • Studies included in a broader systematic review published in 2019 (Hunter et al., 12 studies, search period through August 2016)
  • Studies identified in an update search (5 studies, search period August 2016 July 2020)

The systematic review was conducted on behalf of CPSTF by a team of specialists in systematic review methods, and in research, practice, and policy related to physical activity and the built environment.

Summary of Results

Detailed results from the systematic review are available in the CPSTF Finding and Rationale Statement.

The systematic review included 17 studies that evaluated infrastructure improvements when used alone. Physical activity outcomes reported in the included studies could not be combined to provide summary effect estimates.

  • Ten studies examined changes in moderate-to-vigorous physical activity in the park, trail, or greenway and observed inconsistent effects.
  • Five studies evaluated changes in total physical activity and observed inconsistent effects.
  • Six studies examined other measures of physical activity and observed inconsistent effects.
  • Nine studies examined changes in use of the park, trail, or greenway (regardless of the level of physical activity) and observed a median increase of 32.1%.

Summary of Economic Evidence

An economic review of this intervention was not conducted because CPSTF did not have enough information to determine if the intervention works.

Applicability

Applicability of this intervention across different settings and populations was not assessed because CPSTF did not have enough information to determine if the intervention works.

Evidence Gaps

CPSTF identified several areas that have limited information. Additional research and evaluation could help answer the following questions and fill remaining gaps in the evidence base. (What are evidence gaps?)

  • Do these interventions increase physical activity?
  • Which characteristics of infrastructure improvements are effective in increasing physical activity and use?
  • Are these interventions effective for improving other health and health-related outcomes including the following?
    • Fitness
    • Mental health including measures of anxiety, depression, and well-being
    • Perceptions of social cohesion and connectiveness
    • Injuries
    • Quality of life
  • How effective are these interventions across different communities and populations?
  • How effective are park, trail, and greenway infrastructure improvements alone in reducing perceptions of crime and improving perceptions of safety among members of the community?
  • Which interventions, or combinations of interventions, are most effective in addressing barriers to use of parks, trails, and greenways among the following populations?
    • Communities with lower incomes
    • Older adults
    • People with disabilities

Study Characteristics

  • Study designs included randomized controlled trials (1 study), other designs with a concurrent comparison group (9 studies), and before-after without control (7 studies).
  • Park infrastructure improvements noted in the studies included a new park (1 study), added new structures (3 studies), renovations to existing structures (7 studies), and a combination of new construction and renovations (2 studies).
  • Trail and greenway infrastructure improvements included a new route (1 study) and extensions to existing routes (2 studies).

Analytic Framework

Effectiveness Review

When starting an effectiveness review, the systematic review team develops an analytic framework. The analytic framework illustrates how the intervention approach is thought to affect public health. It guides the search for evidence and may be used to summarize the evidence collected. The analytic framework often includes intermediate outcomes, potential effect modifiers, potential harms, and potential additional benefits.

Summary Evidence Table

Included Studies

The number of studies and publications do not always correspond (e.g., a publication may include several studies, or one study may be explained in several publications).

Effectiveness Review

Andersen HB, Christiansen LB, Klinker CD, Ersb ll AK, Troelsen J, et al. Increases in use and activity due to urban renewal: effect of a natural experiment. American Journal of Preventive Medicine 2017;53(3):e81-7.

Bohn-Goldbaum EE, Phongsavan P, Merom D, Rogers K, Kamalesh V, et al. Does playground improvement increase physical activity among children? A quasi-experimental study of a natural experiment. Journal of Environmental and Public Health 2013:9p.

Buller DB, English DR, Buller MK, Simmons J, Chamberlain JA, et al. Shade sails and passive recreation in public parks of Melbourne and Denver: a randomized intervention. American Journal of Public Health 2017;107(12):1869-75.

Burbidge SK, Goulias KG. Evaluating the impact of neighborhood trail development on active travel behavior and overall physical activity of suburban residents. Transportation Research Record 2009;2135(1):78-86.

Cohen DA, Sehgal A, Williamson S, Marsh T, Golinelli D, et al. New recreational facilities for the young and the old in Los Angeles: policy and programming implications. Journal of Public Health Policy 2009;30:S248-63.

Cohen DA, Marsh T, Williamson S, Golinelli D, McKenzie TL. Impact and cost-effectiveness of family fitness zones: a natural experiment in urban public parks. Health & Place 2012;18(1):39-45.

Cohen DA, Marsh T, Williamson S, Han B, Derose KP, et al. The potential for pocket parks to increase physical activity. American Journal of Health Promotion 2014;28(3 suppl):S19-26.

Dobbinson SJ, Simmons J, Chamberlain JA, MacInnis RJ, Salmon J, et al. Examining health-related effects of refurbishment to parks in a lower socioeconomic area: the ShadePlus Natural Experiment. International Journal of Environmental Research and Public Health 2020;17(17):6102.

Peschardt KK, Stigsdotter UK. Evidence for designing health promoting pocket parks. ArchNet-IJAR: International Journal of Architectural Research 2014;8(3):149.

Quigg R, Reeder AI, Gray A, Holt A, Waters D. The effectiveness of a community playground intervention. Journal of Urban Health 2012;89(1):171-84.

Roemmich JN, Beeler JE, Johnson L. A microenvironment approach to reducing sedentary time and increasing physical activity of children and adults at a playground. Preventive Medicine 2014;62:108-12.

Sami M, Smith M, Ogunseitan OA. Peer reviewed: changes in physical activity after installation of a fitness zone in a community park. Preventing Chronic Disease 2018;15.

Veitch J, Salmon J, Crawford D, Abbott G, Giles-Corti B, et al. The REVAMP natural experiment study: the impact of a play-scape installation on park visitation and park-based physical activity. International Journal of Behavioral Nutrition and Physical Activity 2018;15(1):1-4.

Veitch J, Ball K, Crawford D, Abbott GR, Salmon J. Park improvements and park activity: a natural experiment. American Journal of Preventive Medicine 2012;42:616-19.

West ST, Shores KA. The impacts of building a greenway on proximate residents’ physical activity. Journal of Physical Activity and Health 2011;8(8):1092-7.

West ST and Shores KA. Does building a greenway promote physical activity among proximate residents? Journal of Physical Activity and Health 2015;12:52-7.

Search Strategies

Effectiveness Review

The CPSTF recommendation is based on a systematic review of 38 studies (published through July 2020). The review combined 26 studies of park, trail, or greenway interventions identified from a published systematic review (Hunter et al. 2019; search period through August 2016) with 12 studies identified in an updated search that used the same search terms (search period August 2016 to July 2020).

Hunter et al. (2019) included 38 studies in their review. The Community Guide review team assessed each study based on community guide methods and identified 26 eligible studies for this review. The Community Guide updated search for evidence used a search strategy adapted from Hunter et al. 2019.

Databases searched for this review included Medline, PsycINFO, CAB Abstracts, Scopus, Cochrane, Greenfiles, and Agricultural & Environmental Science Dissertations Environmental Science Collection.

Medline

1 Environment Design/

2 Urban Health/

3 Parks, Recreational/

4 Forestry/

5 (urban adj green adj space).ti,ab.

6 green*space.ti,ab.

7 (open adj space).ti,ab.

8 (public adj space).ti,ab.

9 (public adj open adj space).ti,ab.

10 (park not parkin*).ti,ab.

11 (city adj park).ti,ab.

12 (public adj park).ti,ab.

13 (urban adj park).ti,ab.

14 (municipal adj park).ti,ab.

15 (greenway or urban greenway).ti,ab.

16 (urban adj regen*).ti,ab.

17 (trail* or (urban adj trail*)).ti,ab.

18 (urban adj forestry).ti,ab.

19 water sensitive urban design.ti,ab.

20 WSUD.ti,ab.

21 sustainable urban drainage system*.ti,ab.

22 bio?retention basin*.ti,ab.

23 green roof*.ti,ab.

24 roof garden.ti,ab.

25 living roof*.ti,ab.

26 green wall*.ti,ab.

27 living wall*.ti,ab.

28 vertical garden*.ti,ab.

29 street tree*.ti,ab.

30 green corridor*.ti,ab.

31 green screen*.ti,ab.

32 urban green*.ti,ab.

33 urban conservation.ti,ab.

34 urban naturalization.ti,ab.

35 urban rehabilitation.ti,ab.

36 urban agriculture.ti,ab.

37 or/1-36

38 intervention stud*.mp.

39 randomised control* trial.mp.

40 randomized control* trial.mp.

41 comparative stud*.mp.

42 control group.mp.

43 (randomised or randomized or randomly or groups).mp.

44 quasi*experiment*.mp.

45 natural experiment*.mp.

46 (pre test or pretest or pre intervention or post intervention or post test or posttest).mp.

47 (intervention or interventional or process or program*).mp.

48 (evaluat* or intervention or interventional or treatment).mp.

49 case stud*.mp.

50 retrofit*.mp.

51 or/38-50

52 37 and 51

53 52 not (animals not humans).sh.

54 limit 53 to dt=20200201-20200731

55 limit 54 to english language

56 limit 55 to abstracts

PsycINFO

1 (Environment* adj design).ti,ab.

2 (urban adj health).ti,ab.

3 Parks, Recreational/

4 (urban adj green adj space).ti,ab.

5 green*space.ti,ab. 49

6 (open adj space).ti,ab. 447

7 (public adj space).ti,ab. 784

8 (public adj open adj space).ti,ab.

9 (park not parkin*).ti,ab.

10 (park not parkin*).ti,ab.

11 (city adj park).ti,ab.

12 (public adj park).ti,ab.

13 (urban adj park).ti,ab.

14 (municipal adj park).ti,ab.

15 (greenway or urban greenway).ti,ab.

16 (urban adj regen*).ti,ab.

17 (trail* or (urban adj trail*)).ti,ab.

18 (urban adj5 forestry).ti,ab.

19 (green adj5 roof*).ti,ab.

20 (roof adj5 garden).ti,ab.

21 (living adj5 roof*).ti,ab.

22 green wall*.ti,ab.

23 (living adj5 wall*).ti,ab.

24 street tree*.ti,ab.

25 green corridor*.ti,ab.

26 green screen*.ti,ab.

27 urban green*.ti,ab.

28 urban conservation.ti,ab.

29 urban rehabilitation.ti,ab.

30 urban agriculture.ti,ab.

31 or/1-30

32 intervention stud*.mp.

33 randomised control* trial.mp.

34 randomized control* trial.mp.

35 comparative stud*.mp.

36 control group.mp.

37 (randomised or randomized or randomly or groups).mp.

38 quasi*experiment*.mp.

39 natural experiment*.mp.

40 (pre test or pretest or pre intervention or post intervention or post test or posttest).mp.

41 (intervention or interventional or process or program*).mp.

42 (evaluat* or intervention or interventional or treatment).mp.

43 case stud*.mp.

44 retrofit*.mp.

45 or/32-44

46 31 and 45

47 exp Animals/ not humans.sh.

48 46 not 47

49 limit 48 to up=20200201-20200731

50 limit 49 to (english language and abstracts)

CAB Abstracts

1 (Environment adj design).ti,ab.

2 (Urban adj Health).ti,ab.

3 (recreational adj park*).ti,ab.

4 Forestry/

5 (urban adj green adj space).ti,ab.

6 green*space.ti,ab.

7 (open adj space).ti,ab.

8 (public adj space).ti,ab.

9 (public adj open adj space).ti,ab.

10 (park not parkin*).ti,ab.

11 (city adj park).ti,ab.

12 (public adj park).ti,ab.

13 (urban adj park).ti,ab.

14 (municipal adj park).ti,ab.

15 (greenway or urban greenway).ti,ab.

16 (urban adj regen*).ti,ab.

17 (trail* or (urban adj trail*)).ti,ab.

18 (urban adj forestry).ti,ab.

19 water sensitive urban design.ti,ab.

20 WSUD.ti,ab.

21 sustainable urban drainage system*.ti,ab.

22 bio?retention basin*.ti,ab.

23 green roof*.ti,ab.

24 roof garden.ti,ab.

25 living roof*.ti,ab.

26 green wall*.ti,ab.

27 living wall*.ti,ab.

28 vertical garden*.ti,ab.

29 street tree*.ti,ab.

30 green corridor*.ti,ab.

31 green screen*.ti,ab.

32 urban green*.ti,ab.

33 urban conservation.ti,ab.

34 (urban adj5 naturalization).ti,ab.

35 urban rehabilitation.ti,ab.

36 urban agriculture.ti,ab.

37 or/1-36

38 intervention stud*.mp.

39 randomised control* trial.mp.

40 randomized control* trial.mp.

41 comparative stud*.mp.

42 control group.mp.

43 (randomised or randomized or randomly or groups).mp.

44 quasi*experiment*.mp.

45 natural experiment*.mp.

46 (pre test or pretest or pre intervention or post intervention or post test or posttest).mp.

47 (intervention or interventional or process or program*).mp.

48 (evaluat* or intervention or interventional or treatment).mp.

49 case stud*.mp.

50 retrofit*.mp.

51 or/38-50

52 37 and 51

53 52 not (animals not humans).sh.

54 (202002* or 202003* or 202004* or 202005* or 202006* or 202007*).ud.

55 53 and 54 762

56 limit 55 to (abstracts and english language)

57 from 56 keep 1-617 617

Scopus

( TITLE-ABS ( “environmental design” OR “urban health” OR “recreational parks” OR forestry OR “urban green space” OR “green space” OR “open space” OR “public space” OR “public open space” OR park OR “city park” OR “public park” OR “urban park” OR “municipal park” OR greenway OR “urban greenway” OR “urban regen” OR trail OR “urban trail” OR “urban forestry” OR “water sensitive urban design” OR “WSUD” OR “sustainable urban drainage system” OR ( bio W/1 retention AND basin ) OR “green roof” OR “roof garden” OR “living roof” OR “green wall” OR “living wall” OR “vertical garden” OR “street tree” OR “green corridor” OR “green screen” OR “urban green” OR “urban conservation” OR “urban naturalization” OR “urban rehabilitation” OR “urban agriculture” ) ) AND ( TITLE-ABS-KEY ( “intervention stud*” OR “comparative stud*” OR “case stud*” OR ( clinic* W/1 trial* ) OR ( randomi* W/1 control* ) OR ( randomi* W/2 trial* ) OR ( random* W/1 assign* ) OR ( random* W/1 allocat* ) OR ( control* W/1 clinic* ) OR ( control* W/1 trial ) OR placebo* OR ( quantitat* W/1 stud* ) OR ( control* W/1 stud* ) OR ( randomi* W/1 stud* ) OR ( singl* W/1 blind* ) OR ( singl* W/1 mask* ) OR ( doubl* W/1 blind* ) OR ( doubl* W/1 mask* ) OR ( tripl* W/1 blind* ) OR ( tripl* W/1 mask* ) OR ( trebl* W/1 blind* ) OR ( trebl* W/1 mask* ) ) AND NOT ( SRCTYPE ( b ) OR SRCTYPE ( k ) OR DOCTYPE ( ab ) OR DOCTYPE ( bk ) OR DOCTYPE ( ch ) OR DOCTYPE ( bz ) OR DOCTYPE ( cr ) OR DOCTYPE ( ed ) OR DOCTYPE ( er ) OR DOCTYPE ( le ) OR DOCTYPE ( no ) OR DOCTYPE ( pr ) OR DOCTYPE ( rp ) OR DOCTYPE ( re ) OR DOCTYPE ( sh ) ) ) AND NOT INDEX ( medline ) AND ( LIMIT-TO ( PUBYEAR,2020) ) AND ( LIMIT-TO ( LANGUAGE,”English” ) )

Cochrane

#1 (“urban green space”):ti,ab,kw (Word variations have been searched)

#2 (“green*space”):ti,ab,kw (Word variations have been searched)

#3 (“open space”):ti,ab,kw (Word variations have been searched)

#4 (“public space”):ti,ab,kw (Word variations have been searched)

#5 (Park NOT parking):ti,ab,kw (Word variations have been searched)

#6 (“city park”):ti,ab,kw (Word variations have been searched)

#7 (“public park”):ti,ab,kw (Word variations have been searched)

#8 (“urban park”):ti,ab,kw (Word variations have been searched)

#9 (“municipal park”):ti,ab,kw (Word variations have been searched)

#10 (greenway or “urban greenway”):ti,ab,kw (Word variations have been searched)

#11 urban NEXT/5 regen*

#12 (trail):ti,ab,kw (Word variations have been searched)

#13 (“urban forestry”):ti,ab,kw

#14 (“green roof”):ti,ab,kw (Word variations have been searched)

#15 (“urban green*”):ti,ab,kw (Word variations have been searched)

#16 (“urban naturalization”):ti,ab,kw (Word variations have been searched)

#17 “urban rehabilitation” ):ti,ab,kw (Word variations have been searched)

#18 #1 OR #2 OR #3 OR #4 OR #5 OR #6 OR #7 OR #8 OR #9 OR #10 OR #11 OR #12 OR #13 OR #14 OR #15 OR #16 OR #17 with Cochrane Library publication date Between Feb 2020 and Aug 2020

GreenFILES (Ebsco)

S1 TI ( “environmental design” OR “urban health” OR “recreational parks” OR forestry OR “urban green space” OR “green space” OR “open space” OR “public space” OR “public open space” OR park OR “city park” OR “public park” OR “urban park” OR “municipal park” OR greenway OR “urban greenway” OR “urban regen” OR trail OR “urban trail” OR “urban forestry” OR “water sensitive urban design” OR “WSUD” OR “sustainable urban drainage system” OR “green roof” OR “roof garden” OR “living roof” OR “green wall” OR “living wall” OR “vertical garden” OR “street tree” OR “green corridor” OR “green screen” OR “urban green” OR “urban conservation” OR “urban naturalization” OR “urban rehabilitation” OR “urban agriculture” OR “bio retention basin”) OR AB ( “environmental design” OR “urban health” OR “recreational parks” OR forestry OR “urban green space” OR “green space” OR “open space” OR “public space” OR “public open space” OR park OR “city park” OR “public park” OR “urban park” OR “municipal park” OR greenway OR “urban greenway” OR “urban regen” OR trail OR “urban trail” OR “urban forestry” OR “water sensitive urban design” OR “WSUD” OR “sustainable urban drainage system” OR “green roof” OR “roof garden” OR “living roof” OR “green wall” OR “living wall” OR “vertical garden” OR “street tree” OR “green corridor” OR “green screen” OR “urban green” OR “urban conservation” OR “urban naturalization” OR “urban rehabilitation” OR “urban agriculture” “bio retention basin”)

S2 “intervention studies”

S3 “randomized control* trials” or rtc or “randomised control* trials”

S4 comparative stud*

S5 control group

S6 randomised or randomized or randomly or groups

S7 “quasi* experiment*”

S8 “natural experiment*”

S9 (“pre test” OR pretest PR “pre intervention” OR “post intervention” OR “post test” OR posttest)

S10 (intervention OR inteventional OR process OR programs*)

S11 (evaluat* OR intervention OR interventional OR treatment)

12 “case stud*”

S13 retrofit*

S14 S2 OR S3 OR S4 OR S5 OR S6 OR S7 OR S8 OR S9 OR S10 OR S11 OR S12 OR S13

S15 S1 AND S14

S16 S1 AND S14 Limiters – Scholarly (Peer Reviewed) Journals; Publication Date: 20200201-20200731

Agricultural & Environmental Science Dissertations
Environmental Science Collection

(((((ti((“environmental design” OR “urban health” OR “recreational parks” OR forestry OR “urban green space” OR “green space” OR “open space” OR “public space” OR “public open space” OR park OR “city park” OR “public park” OR “urban park” OR “municipal park” OR greenway OR “urban greenway” OR “urban regen” OR trail OR “urban trail” OR “urban forestry” OR “water sensitive urban design” OR “WSUD” OR “sustainable urban drainage system” OR “green roof” OR “roof garden” OR “living roof” OR “green wall” OR “living wall” OR “vertical garden” OR “street tree” OR “green corridor” OR “green screen” OR “urban green” OR “urban conservation” OR “urban naturalization” OR “urban rehabilitation” OR “urban agriculture” OR “bio retention basin”)) OR ab((“environmental design” OR “urban health” OR “recreational parks” OR forestry OR “urban green space” OR “green space” OR “open space” OR “public space” OR “public open space” OR park OR “city park” OR “public park” OR “urban park” OR “municipal park” OR greenway OR “urban greenway” OR “urban regen” OR trail OR “urban trail” OR “urban forestry” OR “water sensitive urban design” OR “WSUD” OR “sustainable urban drainage system” OR “green roof” OR “roof garden” OR “living roof” OR “green wall” OR “living wall” OR “vertical garden” OR “street tree” OR “green corridor” OR “green screen” OR “urban green” OR “urban conservation” OR “urban naturalization” OR “urban rehabilitation” OR “urban agriculture” OR “bio retention basin”))) AND peer(yes)) AND PEER(yes)) AND ((ti(“intervention studies”) OR ab(“intervention studies”)) OR (ti(“randomized control* trials” OR rtc OR “randomised control* trials”) OR ab(“randomized control* trials” OR rtc OR “randomised control* trials”)) OR (ti(“comparative stud*”) OR ab(“comparative stud*”)) OR (ti(“control group”) OR ab(“control group”)) OR (ti(randomised OR randomized OR randomly OR groups) OR ab(randomised OR randomized OR randomly OR groups)) OR (ti(“quasi* experiment*”) OR ab(“quasi* experiment*”)) OR (ab(“natural experiment*”) OR ti(“natural experiment*”)) OR (ti((“pre test” OR pretest PR “pre intervention” OR “post intervention” OR “post test” OR posttest)) OR ab((“pre test” OR pretest PR “pre intervention” OR “post intervention” OR “post test” OR posttest))) OR (ti((intervention OR interventional OR process OR programs*)) OR ab((intervention OR interventional OR process OR programs*))) OR (ti((evaluat* OR intervention OR interventional OR treatment)) OR ab((evaluat* OR intervention OR interventional OR treatment))) OR (ti(“case stud*”) OR ab(“case stud*”)) OR (ti(retrofit*) OR ab(retrofit*)))) NOT (stype.exact(“Books”) AND la.exact(“ENG”) AND pd(20160801-20200731) AND PEER(yes)))

Review References

Cole H, Triguero-Mas M, Connolly T, Anguelovski I. Determining the health benefits of green space: Does gentrification matter? Health & Place 2019; 57:1-11.

National Recreation and Park Association. Creating equity-based system master plans. Ashburn (VA): 2020. Accessed 12/3/21. Available from URL: www.nrpa.org/publications-research/best-practice-resources/creating-equity-based-system-master-plans/

Hunter RF, Cleland C., Cleary, A., Droomers, M., Wheeler, B.W., et al. Environmental, health, wellbeing, social and equity effects of urban green space interventions: a meta-narrative evidence synthesis. Environment International 2019;130:104923.

Considerations for Implementation

Despite the finding of insufficient evidence, the following are considerations for implementation drawn from the broader literature and expert opinion.

Equitable park access can be defined as the just and fair quantity, proximity, and connections to quality parks, as well as programs that are safe, inclusive, culturally relevant and welcoming to everyone (National Recreation and Park Association 2021). To achieve this, health equity principles can be used to guide park priorities and investments in ways that involve and sustainably benefit communities (Cole et al. 2019).

Implementation guidance incorporating equity considerations is available from several organizations:

The National Recreation and Park Association advocates for parks and recreation throughout communities with emphasis on health and wellness, equity, and conservation.

The Trust for Public Land works to create recreational spaces and provides a tool kit for collaborating with communities in the development of parks.

The Safe Routes Partnership provides fact sheets, toolkits, and infographics to help communities implement active travel to parks.

The Rails to Trails Conservancy provides implementation and equity guidance relevant to trails and greenways.

The City Parks Alliance is a network of leaders in urban parks and recreation that shares research and tools, including those promoting health equity and environmental practices.

Healthy Places by Design works to advance community-led action across the country. They provide reports and action guides for local government leaders and organizations as well as information about their Community Action model.

The Prevention Institute has developed a toolkit for community-based organizations, including a park equity toolkit tip sheet and a webinar series.

Park, trail, and greenway interventions may be linked or coordinated with other elements of the built environment including two CPSTF-recommended approaches to increase physical activity: